Provider Demographics
NPI:1063021582
Name:HERITAGE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-249-5559
Mailing Address - Street 1:29065 SPRINGSHORES DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3151
Mailing Address - Country:US
Mailing Address - Phone:951-467-9555
Mailing Address - Fax:
Practice Address - Street 1:29065 SPRINGSHORES DR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-3151
Practice Address - Country:US
Practice Address - Phone:951-467-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy